In certain health situations, members of Blue Medicare PPO and Blue Medicare HMO are eligible to work one-on-one with a case manager. A provider's patients may be eligible for a case manager if they:
- Have a qualifying complex, chronic or rare condition
- Are at risk for developing a complex and serious medical condition. This may be determined by the patient's answers to the Health Risk survey that he/she completed during enrollment.
- Have been involved in an accident or other catastrophic health event
- Need assistance managing acute or chronic health care needs
Case Management programs (PDF) are available at no additional cost, but copayment and coinsurance for covered services may apply. Case managers can help patients:
- Navigate the health care system
- Identify, implement and monitor their health care needs
- Learn how to prevent falls
- Eliminate barriers to receiving care
- Learn more about their condition, benefits and medications
- Find resources in their community
- Learn about hospice and palliative care, advanced directives, and provide support
- Coordinate services such as home health, skilled nursing facilities, inpatient rehabilitation, hospice, durable medical equipment, transplants and more
